Individual
YARATHA KEDARNATH REDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
380 HOSPITAL DR, SUITE 410, MACON, GA 31217-8001
(478) 972-2558
Mailing address
380 HOSPITAL DR, SUITE 410, MACON, GA 31217-8001
(478) 972-2558
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
006218
GA
367H00000X
Anesthesiologist Assistant
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003112654A
—
GA
05
—
003112654B
—
GA
05
—
003112654C
—
GA
05
—
003112654D
—
GA
01
—
580628385
TRICARE
GA
01
—
625700
WELLCARE
GA
01
—
P01003634
RAILROAD MEDICARE
GA
Enumeration date
08/12/2011
Last updated
06/04/2013
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